高血压合并多重危险因素及靶器官损害患者的治疗指南.ppt

高血压合并多重危险因素及靶器官损害患者的治疗指南葛世俊宁波市李惠利医院心内科?BMJ2003;326:1419?Astrategytoreducecardiovasculardiseasebymorethan80%?减少心血管疾病80%以上的策略?polypill策略:同时针对四种危险因素:lowdensitylipoproteincholesterolbloodpressureserumhomocysteineplateletfunction)?方法:meta-analysesofrandomisedtrialsandcohortstudiesandameta-analysisof15trialsoflowdose(50-125mg/day)aspirin?结果:?Polypill组成:?(forexample,atorvastatin(dailydose10mg)orsimvastatin(40mg));?(forexample,athiazide,ablocker,andanangiotensinconvertingenzymeinhibitor),eachathalfstandarddose;?();?(75mg).?估计:Polypill减少缺血性心脏病88%(84%to91%).减少中风80%(71%to87%).?+抗动脉粥样硬化:降低心血管病超过80%;326:14190%20%40%60%80%100%0%20%40%60%80%100%风险降低(%)缺血性心脏病46%降压药他汀阿司匹林叶酸总计卒中降压药他汀阿司匹林叶酸总计61%32%16%88%63%17%16%24%80%风险降低(%)?该论文意义在于提出了多重危险因素干预的概念(multifactorialinterventions)?多重危险因素干预的理由主要有:1、心血管疾病的主要敌人是动脉粥样硬化2、心血管危险因素有聚集性3、干预单一危险因素效果并不理想MostPatientsHaveOverlappingCVRiskFactorsOfallHypertensives65%havedyslipidemia16%havetype2diabetes45%areoverweight/obeseOfallDyslipidemics48%havehypertension14%havetype2diabetes35%areoverweight/obeseOfallType2Diabetics60%havehypertension60%havedyslipidemia90%areoverweight/orbiditiesincreasesrisk400-700%1BasedonFraminghamrisk高血压人群中,动脉粥样硬化的发生率更高PreventionandControl(2005)1,3–15PDAY研究(PathobiologicalDeterminantsofAtherosclerosisinYouthStudy)?全球15个国家的18个临床中心?1277名因外伤死亡的人群(年龄15-34岁)P<<<(1996):%%%%%